FAQ Category: Elbow

The operation you’re describing is called a submuscular ulnar nerve transposition or SMUNT. It’s one way to treat a condition called cubital tunnel syndrome (CuTS).

The elbow is opened with a long incision to expose the ulnar nerve. The nerve is released from any soft tissue binding it. Then it’s moved over away from the structures pinching it.

We checked with the Naval Medical Center in San Diego where doctors have studied this particular problem. They report patients return to active duty about a month after the operations. There are some activity restrictions for several more months after that.

In a study conducted at that naval base, 19 of the active duty personnel with CuTS returned to their previous jobs after surgery. Only one patient couldn’t meet the physical demands of full, active duty military status.

There are three main nerves that pass by the elbow and go down the arm to the hand and fingers. The nerves go through the soft tissues and can get pinched or trapped under a ligament or between two muscles.

Ganglion cysts, tumors, and repetitive overuse are other possible causes of pressure on the nerves. Sometimes narrowing of the hole where the nerve comes out of the neck can
give these same symptoms. This is more common in the aging spine.

Posture can make a difference. Slumped shoulders, rounded upper back, and a forward position of the head can put pressure on the nerves. A medical exam is probably needed to get to the bottom of your problem.

Elbow pain can be coming from a local problem in or around the joint. But elbow pain and other symptoms such as numbness or tingling in the forearm and hand can also come from a neck problem. The nerves to the arms and hands leave the spinal cord and travel down the
extremity.

Bone spurs, arthritis, or cervical spine degeneration can put pressure on the spinal nerves in the neck area. The symptoms can be the same whether the problem starts in the neck, elbow, or forearm.

Taking a neck X-ray can help rule out the neck as part of the problem. No one wants to have surgery on the elbow only to find out the problem was coming from someplace else. A thorough exam for some elbow problems includes checking for the source of the problem above and below the elbow. This means the doctor looks at the neck and shoulder as well as the wrist and hand before assuming the problem comes directly from the elbow.

Studies haven’t been able to show one treatment is better than all the others. They seem pretty much even. Physical therapy has been matched against steroid injections and a “wait-and-see” approach. There wasn’t much difference in the results for each type of treatment.

A recent study compared a program of forearm stretching and extracorporeal shock wave therapy (ECWT) with stretching and sham ECWT. Again, there wasn’t enough difference in results to say one was better than the other.

Certainly, avoiding activities that bring on your symptoms or make them worse should be avoided. This may be the best advice until more studies find out what really works.

There are several steps in the selection of subjects for a science project. Start with age. Do you want to include people of all ages? Or only certain ages such as 21 to 50 or over 50. What about gender? Should you include males and females? Or do you want a group of only one gender (males only) to control variables such as hormonal changes?

Will you include people who have been treated for their tennis elbow? What if they are currently receiving treatment of some kind? Will that conflict with the data you’re trying to gather?

You’ll need to select a sample size. Your science or math advisor should be able to help you use the formula (or software) that calculates what number would be statistically significant. Subject size may be affected by what you are going to use as a measure of success. Will success be defined by the amount of pain relief obtained? Days missed at school or work? Patient’s level of quality of life?

Once you have all the variables defined, then you can start advertising. You may want to put flyers or posters up at health clubs or fitness centers, factories, and golf or tennis clubs. Depending on the ages chosen, you may want to put notices in college newspapers. Other places to post your need for subjects may include the public library, local hospitals, and even the public service announcements of the local newspaper.

It’s best to get more than the actual number needed. There are always people who don’t finish the study for a variety of reasons. Good luck with your efforts!

Shock wave therapy is a newer method of treatment for tennis elbow. Pulses of high-pressure (low energy) sound are directed at the injured part of the tendon.

The “shock” refers to the high pressure. This pressure breaks down scar tissue. It helps new blood vessels grow in healthy tissue which can reduce pain. The treatment takes about 20 minutes once a week. Three or four sessions are advised.

Studies of this treatment have mixed results. Some say it relieves pain while others say it doesn’t work any better than anything else. It’s not clear who the ideal patient is for this treatment. There are very few side effects so some people want to try it before going to something more invasive like surgery. A few patients report increased aching, soreness, or pain after treatment.

Iontophoresis is a process that uses a mild electrical current to deliver drugsacross the skin into the soft tissues. It’s a local treatment so the effect of the medication is on the elbow, not throughout the body.

Iontophoresis has been around as a form of treatment for tennis elbow since the 1940s. Research and testing has shown it’s both safe and effective. Any problems in its use are usually linked to the way it’s used, not to the concept itself.

New, updated technology has brought iontophoresis back as a popular form of treatment. Many patients prefer this delivery system to steroid injections. It’s pain free and delivers the drug over a larger area than a needle.

In simple terms, the elbow’s connected to the upper arm. The upper arm is connected to the shoulder, and the shoulder’s connected to the neck. Everything works together for smooth, pain free motion.

In more complex terms, changes in the spinal cord may be the key. The spinal cord passes through the bones of the neck called the cervical spine. Any changes in the line up of the bones in the spine may cause the spinal cord to react. This is called
central sensitization.

So the symptoms of tennis elbow may actually start in the neck rather than in the elbow itself. Treatment of the neck may change the way pain messages are sent and delivered by
the spinal cord.

The therapist helps restore normal motion in the joints of the cervical spine. This type of treatment is called manual therapy. Some studies show patients with tennis elbow get better faster when manual therapy of the neck and/or elbow are used instead of
just local treatment to the elbow.

“Tennis elbow” is also known as lateral epicondylitis. It’s most commonly seen in industrial workers. Repeated wrist or arm motions can bring it on. In others, it comes on without warning and with no known cause.

About one-third of all patients with tennis elbow can’t identify a cause or reason for their symptoms. Sometimes there’s a reason but the patient doesn’t connect the activity with the symptoms. It could be a motion repeated over and over at work. It could be related to leisure or sports activities.

Scientists don’t really know what brings this problem on. If it is just linked with overuse, then why doesn’t everyone using that motion or doing the same job develop the problem? More research is needed to answer these questions before the problem is solved.

Doctors are studying this question. A closed release is done with an arthroscope. This tool allows the doctor to go through the skin and into the joint with only a puncture hole. A tiny TV camera on the end allows the doctor to see inside the area. An open release involves a cut or incision to open the skin, muscle, and joint. In both operations, the tendon is released and then repaired and reattached.

A recent report suggests there’s no difference between these two methods in the long-run. Short-term results may be the key. In a study of 87 patients (54 open, 33 closed), results were the same after two years. But the arthroscopic group started rehab and went back to work sooner than the open group. The open group also needed more therapy after the operation.

The small number of patients in this study makes it a preliminary report. More studies with more patients are needed before a final summary can be made. In the meantime, it might be best to go with whatever method your doctor has the most experience with.

Tennis elbow occurs most often when a patient has overused the forearm and elbow or has repeated the same motion over and over. Small, repeated tears develop in the extensor carpi radialis brevis (ECRB) tendon. Inflammation sets in. Then scar tissue develops.
Sometimes small bits of bone form inside the tendon. This is called calcification.

The chronic motion added to the calcification can cause microtears to become full tears or tendon ruptures. Pain and loss of motion in the wrist and forearm may not
respond to therapy. In such cases, an operation is needed to repair the damage.

In the case of a partial tear, the doctor will release the rest of the tendon from the bone. Any scar tissue formed will be removed. The bone may be shaved down to give the tendon a smooth surface to glide across. Then the tendon is reattached to the bone where it belongs. Sometimes a special button or anchor device is used to hold the tendon in place until it heals.

After the operation, you may be in a supportive wrap and sling. Range of motion exercises usually start that day or the next day. After 10 days or so, you’ll be getting rid of the sling and moving the arm normally. Strengthening exercises may begin right away or up to six weeks later. This depends on the doctor and the method used to release and repair the tendon.

Most studies show that patients with tennis elbow get better without surgery. This is true even if the tendon is ruptured. The therapist will help you figure out which movements brought on the problem and how to change your movement patterns.

Other rehab techniques will be used to help foster healing and promote normal tendon gliding. Surgery is usually saved for patients who don’t get better with more conservative treatment. Doctors wait six months or more before suggesting surgery.

You may be describing some signs of nerve involvement. Are your symptoms better, same, or worse when you bend your head toward the side of the elbow symptoms? Symptoms such as you described suggest tension on the nerve. This is especially true if your symptoms are better or go away when you bend toward the side of the tennis elbow.

Stretching usually helps tight muscles lengthen and relax. In your case you may need to stretch the nerve as it goes from the neck down the arm and into the hand. This can be done but you’ll probably need a physical therapist to help you learn how.

If your symptoms aren’t better after just a few sessions of nerve gliding and stretching, you may need some nerve testing to find out where the problem is coming from. You’ll need to see a medical doctor for this kind of testing.

Thank you! And there’s a study to back you up on this. Researchers in Canada found that workers with tennis elbow using their forearm at least 25 hours/week have poorer results after treatment than those with fewer hours at the computer. Repetitive-work tasks appear to be the problem.

hanging the computer station at home and at work can help patients recover from tennis elbow … even when the tennis elbow came from a sports injury. Women (and especially women with neck or nerve pain) also had a slower recovery time.

Finding risk factors like these can help therapists and patients alike in planning the best rehab program. It will help predict how long recovery may take.

Tennis elbow can affect the outside of the elbow (lateral tennis elbow) or the inside (medial tennis elbow). Lateral tennis elbow is the most common muscular problem in the upper limb. Studies suggest one to three percent of the adult population is affected each year.

Some patients have no idea what caused the problem. Other report work-related or sports activities as the problem. The number of people with tennis elbow may continue to increase as adults work long hours at repetitive tasks or at the computer keyboard. Numbers may also increase as Americans try to stay in shape with exercise like tennis that can bring on tendonitis.

You may know botulinum toxin type A as the more common trade name of Botox. Botox was first made and used in the 1980s for blepharospasm. This is a condition in which the eyelid won’t stay open because of a muscle spasm. Botox has also been used to treat neck and arm muscle spasms. More recently it has gained in popularity as a treatment for facial wrinkles.

It has been used on a trial basis for tennis elbow. The injection works as a nerve block. It binds to the nerves that lead to the elbow extensor muscles. By preventing the release of a neurotransmitter called acetylcholine it keeps the muscle from contracting. Botox injection works for three or four months. When used for tennis elbow, this amount of time may give the muscle a chance to heal.

A recent study from England compared Botox injections for chronic tennis elbow to a placebo (saline) injection. All patients had pain and loss of function from tennis elbow for at least six months. They had all had at least one corticosteroid injection and physical therapy without results.

There was no difference between the two groups after three months. Pain levels, quality of life, and grip strength remained the same before and after treatment. Other studies comparing Botox injections to surgery showed Botox to be more effective. More studies are needed before Botox can become a primary treatment for tennis elbow.

Botulinum toxin type A or Botox is a nerve blocker used to paralyze muscles in spasm. It’s been used to treat a wide variety of problems. These include muscle spasms from brain injury, multiple sclerosis, or stroke. There has been some success using it for spasticity in children with cerebral palsy. You may be more familiar with its recent use for deep facial lines and wrinkles.

Spasms of the hand, including writer’s cramp and musician’s cramp have been treated with Botox. It has been used in small studies for tennis elbow. The main (intended) side effect in the treatment of muscle spasm is muscle paralysis. Finger drop also known as extensor lag can occur.

The affected individual is unable to extend the finger(s). In other words, the finger(s) stays in a flexed or bent position. The effect is often temporary lasting only three to four months at the most. An occupational therapist can help you with a splint. The splint holds your finger in the right position to use it. A special splint may be needed that will allow you to use your guitar. Take your guitar with you to the appointment.

Corticosteroid injections remain one of the most common first treatments for tennis elbow. The local injection of this anti-inflammatory can help reduce pain and restore function.

Doctors aren’t sure why it works since there isn’t any inflammation present in chronic tennis elbow. It may be a placebo effect, meaning the person would get just as much relief from an injection of saline or some other neutral agent. There’s some thought that the needle puncture is the real treatment. Dry needling may be all that’s needed.

Botulinum toxin type A or Botox has also been used for chronic tennis elbow with limited success. One study at the Wrightington Hospital in England showed no effect from Botox injection in a group of 20 chronic elbow pain patients. Twenty other patients got a placebo injection for comparison. There were no differences between the two groups in terms of pain, grip strength, and quality of life.

Injectable steroids can be very helpful for pain and swelling from arthritis and other conditions like tennis elbow. There are potential side effects to be aware of. Some are local effects like dimpling in the skin and tissue underneath or even increased pain. Others are systemic (affecting the whole body) such as muscle damage.

Most doctors agree that injections into the same joint should be done no more than once every three months. You should know this isn’t based on solid research evidence. It’s just a rule of thumb that doctors have adopted over the years. It may be possible to have injections more often without problems.

Doctors have described tennis elbow for the last 130 years. Despite how old the problem is, its treatment remains a mystery. Surgery may offer reliable relief from the pain but other problems persist. For example, like you, many patients may still be limited in what they can lift and in their grip strength.

Most often results after surgery for tennis elbow can be improved with a rehab program. Control of pain and swelling are the early goals. Since you’re several months past the operation strengthening exercises can be added.

Talk to your doctor about a rehab program. Maximum improvement may not be reached until a full year after the operation.